6 P.M.SEPT. 16, 2014
The average age in the U.S. for patients needing a hip replacement is 65. However, the age group where the number of such surgeries is increasing the most is among those in their 50s.
The reasons for that are not entirely clear.
According to Dr. Nithin Reddy, an orthopedic surgeon at Kaiser Permanente San Diego, it’s thought that the obesity epidemic might play a role in the need for the procedure. He also said it may have to do with the fact that more and more people are staying active later in life.
No matter what the reason the surgery is needed, the procedure has undergone changes over time that often lead to a more speedy recovery for patients.
Dr. David Amory, an orthopedic surgeon at Tri-City Medical Center, said the procedure involves complete replacement of the hip joint — which involves a ball and socket. The pelvic socket is resurfaced and the thigh bone ball is replaced with a new ceramic or metal ball.
According to the Agency for Healthcare Research and Quality, he said more than 285,000 total hip replacements are performed each year in the U.S., and surgeons are constantly reminded that those numbers are expected to increase as the population ages.
In about 90 percent of cases, Reddy said osteoarthritis is the reason why the surgery is needed. He said over time, osteoarthritis damages the joints, cartilage and the environment of the joint and leads to severe pain.
Yet he said before surgery, a minimum of three months of conservative measures are typically taken, including having the patient try low-impact activity such a walking, cycling or swimming; physical therapy; using walkers or canes; and medications such as anti-inflammatory drugs, over-the-counter pain relievers or injections.
“One indication for surgery is when conservative measures no longer work,” he said.
The good news, he said, is that of all joint replacement surgeries, hip replacement is among the most successful in terms of recovery and outcomes. He said studies indicate that 95 to 97 percent of hip replacement patients have good to excellent outcomes, while by comparison, 80 to 85 percent of knee replacement patients report the same high level of results.
Amory said new developments are also allowing hip replacements to last longer, and newer techniques to perform the surgery have decreased recovery time. Additionally, newer techniques in anesthesia have decreased post-operative pain.
During a hip replacement, Amory said an incision is made either anteriorly directly over the hip or on the side. The femoral head — or the ball — is removed and the socket is then cleared of tissue and reamed to a certain size to accommodate a cup component. The cup — which is made of titanium with a porous surface to facilitate in-growth of bone — is hammered into the socket, and in some cases, fixed with screws. A polyethylene liner is placed into the metal shell to act as a smooth surface for the ball component. A titanium “stem” is then “press fit” into the thigh bone.
